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Patterns of maternal transport in a state with levels of maternal care and no formal perinatal regions
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Patterns of maternal transport in a state with levels of maternal care and no formal perinatal regions

Jingyu Li, Lauren N. Steimle, Margaret Carrel, Riley A. Byrd and Stephanie M. Radke
medRxiv
Cold Spring Harbor Laboratory Preprints
04/22/2026
DOI: 10.64898/2026.04.20.26351263
url
https://doi.org/10.64898/2026.04.20.26351263View
Preprint (Author's original) This preprint has not been evaluated by subject experts through peer review. Preprints may undergo extensive changes and/or become peer-reviewed journal articles. Open Access

Abstract

Purpose To characterize maternal transport patterns in Iowa, a state with levels of maternal care and without formal perinatal regions, and assess whether transport decisions reflect efficient, risk-appropriate coordination. Methods We analyzed 2010-2023 Iowa birth records, which included 2,251 maternal transports between obstetric facilities across 106 unique routes. We characterized transport patterns and applied a community detection algorithm to identify “communities” of obstetric facilities that disproportionately transport among themselves. Findings Suburban and rural counties have elevated transport rates compared to urban counties. 2,189 transports (97%) were from lower-to higher-level facilities. Among these, 2,037 (93%) were to Level III tertiary care centers. 567 transports (25.2%) bypassed a closer facility offering an equivalent or higher level of care than its destination facility. Health system affiliation was associated with bypassing transport, indicating potential organizational rather than purely geographic drivers of transport decisions. Three “communities” of obstetric facilities largely shaped by geographic proximity were identified. Conclusions Although Iowa does not have formal perinatal regions, patterns of maternal transport are mostly in line with three de facto regions. Some potential inefficiencies were identified, such as obstetric facilities transporting to a farther facility when a closer facility offered the same level of care or higher. These findings may help identify opportunities to enhance care coordination among obstetric facilities, optimize maternal transport networks, and improve regionalization of maternal care.

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